Sisson Organizational Forms R GEIV ED
JUL 1$ 2013
'..Amendment
Statement Organization - Candidate Committee ❑ Yes KNo
NHC Bde ti n 19create a new or update an existing candidate committee.
This form must be accompanied by forms CRO-3100 and CRO-3500(when amending,only re-submit if applicable).
1.Committee Information
Full Name c.Ill Number
0 o mry\ U le :S(sson Neo-I "A ea I-C 1
b.Mailing Address(include City,State and Zip Code) d.Date Organized
'{'10 Co Oleander If,
' e.Phone Number
1rrnt N��o`� , N C, a$�kc�3 qio-;1%- Igq
2.Candidate Information ❑Candidate's Primary Committee
a.Full Name c.Candidate IU Number f.Part.Affiliation
(Indicate Non-partican if applicable)
b.Mailing Address(include City,State,and'Zip Code) g.Office Sought
1 co sh fe, r. ma o� _
w ' h �� n,�,a���a
c.Phone Number d.EmaiLAddress h.Next Election Year i.Jurisdict��i��onll I,1,
����b1�g� �IgrlTSv� Ile �0.Cv
❑Email copy of notices �� 5
3.Treasurer Information' 1. Custodian of Books Information
a.Full Name a.Dull Name
ce, P. N-i4ma5
b.Ntailin ddress(include City,State,and Zip Code) b.Mailing Address(include City,State,and Zip Code)
l{ol �lbemasle P-.EQ
1� 1 NC al;�q0 S
c.Phone Number d.Email Address c.Phone Number Id.Email Address
cUo-(otd- 4 )pC y mas e be,l6jh, e
I prefer to receive notices by email AVes El No El Email co p» of notices
5.Assistant Treasurer Information Add 7 Account Information (incl.CRO-3500) Add
a.Full Name ❑ Remove a.Financial Institution Full Name ❑,Remove
rod tl� Lkri ion
b.Mailing Address(include City,State,and Zip Code) b.Purpose
0a_rnjXL6?,r)
e n seS
c.Phone Number Id.Email Address c.Account Code d.Type
Email co of notices l�JS3� CheC. '.in
CERTIFICATION
I certify that the Committee or Fund is in compliance with all applicable provisions of Article 22A,22B&22D-22M of
Chapter 163 of the NC General Statutes and that no funds are commingled with prohibited or other non-disclosed funds.
I further certify that this report is complete e and correct.
-111 ilc�o La
Printed Name of Signer gn re of Appointed Treasurer Ale
CRO-210" NC State oard of Elections Nl1 i\ '_td 1
RECEIVED
JUL 1$ 2013ss
North Carolina NHC Bd of Elections
State Board of Elections
441 N Harrington Street
Raleigh,NC 27603
Kim Westbrook Strach flailing Address
Executive Director PO Box 27255
Raleigh,NC 27611-7255
(919) 733-7173
Fax: (919) 715-8047
Candidate Designation of Committee Funds
This form is used by candidate committees only and allows the candidate to designate in the event of their death,
how the committee's funds are to be disbursed using the eight allowable methods outlined in 163-278.1613(a).
Candidate Name: I l l 51
Committee Name: O_pM MI'Wee. T'o �2 ill I SSC�?7
Treasurer Name: VO�A e 2 1'. l.h 1`I ShYY1gS
If Candidate is own treasurer, designate an agent to carry out designations:
Committee ID#: New - i H A Ga i -C-co
Level Registered: [State] [County] If county, specify: NEI&) 'HcZMyef,
I, 715 1` 11 5 fzzo Yl hereby direct that in the event of my death or incapacity all
(Name of Candidate)
funds remaining in my Campaign Committee account(s) (after payment of permitted outstanding
debts or reasonable expenses for winding up the Committee or closing office) be paid in the
following manner as permitted by N.C. Gen. Stat. 163-278.16B(a).
Name of Entity Plan for Disbursement (eg. Amount or %)
(Select from¢163-278.16B(a))
to Cmf6 b I 1W qU
2.
3.
By signing this form, I certify that the foregoing entities are eligible beneficiaries under N.C.
Gen. Statute 163-278.16B(a). A copy of this form should be maintained with the Committee
records.
Signature of Candidate:
Date:
Note:This Designation is to be filed with the Election Board where the committee's campaign reports are filed.
CRO-3900 Candidate Designation of Committee Funds Mai•2013
' RECEIVED
North Carolina JUL 18
State Board of Elections NHC Bd of Elections
441 N Harrington Street
Raleigh,NC 27603
Kim Westbrook Strach Mailing Address
Executive Director PO Box 27255
Raleigh,NC 27611-7255
(919) 733-7173
Fax: (919) 715-8047
Certification of Treasurer
This Certification is used by Candidate Committees to appoint a treasurer to the committee.This form is
required and must accompany the Candidate's Statement of Organization
FILED BY:
Candidate Name: j 11 jSO
Treasurer Name: C2 P.
Treasurer Address: 2
(include city,state, &zip) �AD',YN l 1"�" N
Treasurer Phone: �� — °(�j a_g S5 4
I certify that the above information is correct,and I,as candidate,appoint said treasurer to personally fulfill
the duties and responsibilities imposed upon the appointed treasurer and subject to the penalties and
sanctions in Subchapter VIII. Regulation of Election Campaigns of Chapter 163 of the North Carolina
General Statutes.
I understand that if the above Treasurer changes,it will be necessary to certify a new treasurer and amend
the existing Statement of Organization within 10 days of the vacancy. I further understand that the above
Treasurer is required to receive training by the State Board of Elections within three months of this
appointment according to Article 163.278.9(k).
Date Signed Signature of Candidate
Note:This Certification is to be filed at the Election Board where the committee's campaign reports are tiled.
CRO-3100 Certification of Treasurer Mm,2013